Speaker Application 2018

If you would like to give a talk at KRIYA Conference 2018, please FIRST fill out the regular Application form for all conference participants, and THEN fill out this Speaker Application form (below).

Speakers are welcome to give a talk on the topic of your choice about ketamine, or to present 1-2 clinical cases (preferably a case where things did not go well, or where you had a clinical question). Speakers will get 20-40 minute slot for your presentation, plus additional time for Q&A. All Speakers are also expected to participate in the panel discussions about various aspects of ketamine treatment.

A $200 discount is available for each speaker slot (only 1 discount per slot).

Speaker Application Form

First Name

Last Name

Email Address

Clinic or business name

Phone Number(s)

I have filled out the Guest Application form.

Yes

No

Title of your talk

Description of talk. Please provide an abstract or an outline of the main points that you are planning to cover. Be sure to describe the dose, ROA, and setting in the box below.

I give permission to KRIYA Institute to fill out a “Financial Disclosure of Commercial Interests”form on my behalf so that CME can be awarded for this conference.

I Agree

I Do Not Agree

Have you (or your spouse) had any relevant financial relationships with any proprietary entity in the past 12 months?

Yes

No

This entire meeting will be recorded by audio and video by event staff. These recordings will become the property of KRIYA Institute. These recordings (or portions of these recordings) may be made available to the public in the future.

I Agree

I Do Not Agree

KRIYA Institute would like to post your slideshow on the KRIYA Institute website. You are welcome to edit your slides before they get posted; the edited slideshow is due 1 week after KRIYA Conference.